title: Effect of adjuvant iridium-192 brachytherapy on the survival of patients with malignant gliomas.
abstract: The effect of iridium-192 brachytherapy (BRTX) on the survival of patients with malignant gliomas was evaluated in 83 patients with malignant gliomas (42 astrocytoma grade III, 41 glioblastoma multiforme) over a period of 8.5 years. Fifty patients (Group 1) received only standard external beam radiotherapy (EBRT) (mean dose 51.5 +/- 12.4 Gy in 2.0 Gy fractions), and 33 patients (Group 2) received EBRT (mean dose 51.0 +/- 10.8 Gy) combined with BRTX (mean dose 50.2 +/- 13.2 Gy, dose rate of 0.3-0.4 Gy/hr). The median survival periods for patients in Groups 1 and 2 were 12.2 and 23.7 months, respectively (p = 0.0145). The median survival for 17 patients in Group 2 with glioblastoma multiforme was 21.9 months. Using BRTX as an adjuvant to EBRT appeared to confer survival benefits compared to only EBRT (p = 0.0284). Univariate and multivariate analysis identified the variables of histological diagnosis, location, Karnofsky performance status, and BRTX as relevant risk factors for survival time (p < 0.05 for each factor). Among these factors, BRTX was the most important for prolonging survival (p = 0.0015). Adjuvant iridium-192 BRTX and conventional EBRT appears to greatly improve the survival time of patients with malignant gliomas compared to only EBRT and may be the treatment of choice in selected patients with tumors located in deep-seated or eloquent areas.
authors.affiliation: Department of Neurological Surgery, Okayama University Medical School.
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
authors.forename: T
authors.initials: T
authors.lastname: Nakagawa
authors.forename: E
authors.initials: E
authors.lastname: Tada
authors.forename: T
authors.initials: T
authors.lastname: Furuta
authors.forename: Y
authors.initials: Y
authors.lastname: Hiraki
authors.forename: T
authors.initials: T
authors.lastname: Ohmoto
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D015173:Supratentorial Neoplasms / Q000532:radiotherapy*; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D007496:Iridium Radioisotopes; D009607:Nitrosourea Compounds; C020766:ranimustine